State and federal courts mandate that inmates must have access to adequate health services in prison. However, that mandate usually covers only “severe or serious” mental illnesses, according to the paper. As such, many inmates with mental health conditions such as depression, anxiety, and posttraumatic stress disorder do not get the care they need, leaving them vulnerable both within prison and upon reentry to society.

“Individuals with untreated mental health conditions may be at higher risk for correctional rehabilitation treatment failure and future recidivism after release from prison,” said Dr. Jennifer Reingle, Ph.D., principal investigator and assistant professor in the Division of Epidemiology, Human Genetics and Environmental Sciences at the University of Texas Health Science Center at Houston (UTHealth) School of Public Health.

Data for the study came from a 2004 national sample of state and federal prisoners, which included 14,499 participants in state prisons and 3,686 in federal prisons. Participants self-reported whether they had been taking medication for a mental health condition upon entering the facility and whether they were still taking medication while in prison, marking treatment continuity.

Medication discontinuity prevalent in state and federal prisons

Overall, just under one-third of the inmates reported having a mental health diagnosis. The most prevalent mental health condition among prisoners was depression — reported by 20 percent of inmates — followed by mania, anxiety and post-traumatic stress disorder.

At the time of admission, 18 percent of each sample (state and federal inmates) was taking medication for a mental health condition, but only 52 percent of that subset of the population in federal prisons and 42 percent in state prisons received medication during their sentence.

“Screening tools are not consistent across prisons and inmates could be diagnosed with different conditions or not diagnosed at all when they get transferred to a new location,” said Dr. Reingle. “A standardized mental health screening process could benefit the inmates and the prison system as a whole.”

The study also found evidence of racial disparities in medication continuity. African American participants were 36 percent less likely than other inmates to have medication continuity in prison, regardless of their diagnosis. African Americans were also more likely to suffer from schizophrenia than Caucasians. Overall, participants with schizophrenia were more likely to get medication in prison and to have treatment continuity.

More holistic approach could improve outcomes, lower recidivism

Since some mental health disorders such as schizophrenia influence behavior, those prisoners may receive medication to maintain security in the prison environment, Dr. Reingle said. Since depression does not pose a significant security risk, it’s less likely that depressed prisoners will be easily identified and treated, she added.

Previous studies suggest that former offenders who were diagnosed with a mental health condition were 70 percent more likely to return to prison compared to inmates in the general prison population.

In the study, researchers found that among the participants who were taking medication for a mental health condition in prison, 61 percent used no other form of treatment. A more holistic, multidimensional approach to treatment, such as counseling or group therapy, would likely lead to better outcomes and lower recidivism rates in this population, said Dr. Reingle.